Apelin as a Potential Regulator of Peak Athletic Performance.

Apelin, as a cardiokine/myokine, is emerging as an important regulator of cardiac and skeletal muscle homeostasis. Loss of apelin signaling results in premature cardiac aging and sarcopenia. However, the contribution of apelin to peak athletic performance remains largely elusive. In this paper, we assessed the impact of maximal cardiorespiratory exercise testing on the plasma apelin levels of 58 male professional soccer players. Circulating apelin-13 and apelin-36, on average, increased transiently after a single bout of treadmill exercise; however, apelin responses (Δapelin = peak - baseline values) showed a striking interindividual variability. Baseline apelin-13 levels were inversely correlated with those of Δapelin-13 and Δapelin-36. Δapelin-13 showed a positive correlation with the maximal metabolic equivalent, relative maximal O2 consumption, and peak circulatory power, whereas such an association in the case of Δapelin-36 could not be detected. In conclusion, we observed a pronounced individual-to-individual variation in exercise-induced changes in the plasma levels of apelin-13 and apelin-36. Since changes in plasma apelin-13 levels correlated with the indicators of physical performance, whole-body oxygen consumption and pumping capability of the heart, apelin, as a novel exerkine, may be a determinant of peak athletic performance.

Predicting cervical screening and HPV vaccination attendance of Roma women in Hungary: community nurse contribution is key.

BACKGROUND: HPV screening/vaccination has been observed lower for ethic minorities. Understanding factors that predict and can improve attendance is therefore key. Hence, the aim was to identify causes, especially concerning the quality of the patient-provider relationship, that predict past HPV screening and vaccination turnout of Roma women in Hungary. METHODS: Cross-sectional research design with self-developed, culturally sensitive questionnaire. A final, female Roma sample of 368 participants was randomly selected from census register. Community nurses contacted participants and distributed surveys. Surveys were mailed-in by participants. Bivariate logistic regression was used to predict former participation in HPV screening/vaccination. RESULTS: Of the total sample, 17.4% of women attended at least one cervical screening and HPV vaccination in the past. Bad screening experience was positively associated with racially unfair behaviors of physicians. The odds of past attendance were 4.5 times greater if 'no negative earlier experience' occurred, 3.3 times likelier if community nurse performed screening/immunization and 1.6 times more probable if respondent felt 'no shame'. Evaluating the screening/vaccination process painful, being only financially motivated and attendance involving a lot of travel decreased the odds of 'no show' by 50%, 40% and 41%, respectively. CONCLUSIONS: When considering the ratio of past cervical screening attendance, we conclude that our female Roma sample did not behave differently from the general population. We saw no evidence that racial mistreatment made any contribution to explaining cervical screening participation. Past positive screening experience and the quality of patient-provider relationship increased the odds of participation the most. Cancer of friends, pain, financial motivation and travel distance decreased odds of participation to a lesser extent. In order to improve future screening and immunization, community nurses should play more central and advanced role in the organization and implementation of such services specifically targeting Roma populations.

[Adolescents' sleep quality in the context of Internet use]. / Serdülok alvásminosége az internethasználattal összefüggésben.

Background and purpose: Background and purpose - The present study is a continuation of our previous research, our aim is to assess the sleep quality of adolescents in light of Internet use. Methods: We conducted a cross-sectional, quantitative, descriptive questionnaire survey among students aged 12-18 in primary and secondary education (n = 308). A self-edited questionnaire, a scale of sleep hygiene rules, and the Athens Insomnia Scale were used. Results: On the Athens Insomnia Scale, they scored an average of 5.39 (3.93) points, with 17% of adolescents considered insomniac. Students watch an average of 1.27 (1.04) hours of film a day, and 47% of them use the Internet for more than two hours a day. Excessive internet use (p < 0.001) and use of smart devices before falling asleep (p = 0.002) have a negative effect on sleep quality. Stress increases in parallel with Internet use (p = 0.001). Those who sleep better perform better in school (p = 0.034). Conclusion: Excessive use of smart devices is associated with higher stress levels and poorer sleep quality. Our goal is to draw the attention of parents and adolescents to the reduction of Internet use and the possible consequen-ces of deteriorating sleep quality.

Reaction Kinetics Modeling of eHsp70 Induced by Norepinephrine in Response to Exercise Stress.

Exercise elicits a systemic adaptation reaction, involving both neuroendocrine and cellular/paracrine stress responses, exemplified by the sympathoadrenergic activity and the release of cellular Hsp70 into the circulation. Regular sports training is known to result in increased fitness. In this study, we characterized the plasma norepinephrine and Hsp70 levels and modeled their relationship in response to exercise stress by bicycle ergometer in 12 trained judoka athletes and in 10 healthy controls. Resting norepinephrine was similar in both groups, whereas Hsp70 was significantly higher in controls compared to athletes. Intense exercise load induced both norepinephrine and Hsp70 elevation. However, both norepinephrine and Hsp70 were significantly lower in athletes compared to the control group. A reaction kinetic model was developed that provided a quantitative description of norepinephrine-facilitated extracellular Hsp70 release, congruent with the experimental data. Our study indicates that exercise-induced norepinephrine and extracellular Hsp70 may be coordinated responses to physiological stress, which are robustly affected by regular sports activity.

Paediatric nurses' burnout, quality of life and perceived patient adverse events during the COVID-19 pandemic: Testing an integrated model using structural equation modelling.

PURPOSE: A model was hypothesised by integrating two theoretical models: the compassion satisfaction-compassion fatigue and empowerment models. This study aimed to assess the extent to which this integrated model can explain the relationships between paediatric nurses' burnout quality of life, perceived patient safety and work-related variables during the COVID-19 pandemic. BACKGROUND: Nurses' burnout is negatively associated with quality of life (QOL) and positively with patient safety. Several theoretical models were introduced to explain burnout determinants and outcomes such as Golembiewski, Munzenrider and Stevenson model, Leiter and Maslach's process model, and Lee and Ashforth's model. However, few models described burnout in relation to QOL or patient safety. METHODS: A sample of 225 paediatric nurses responded to questionnaires about burnout, QOL, adverse events and work-related variables. Compassion satisfaction - compassion fatigue and empowerment models were integrated into a single model and tested using structural equation modelling analysis. This study was prepared and is reported according to the STROBE checklist. RESULTS: The final model explained 65% of the variance of burnout and 37% of the variance of QOL. The work-related variables (co-workers' support, job satisfaction, satisfaction with the monthly salary, participation in continuous education and exposure to violence) are predicting paediatric nurses' burnout and quality of life. CONCLUSION: The Compassion satisfaction - compassion fatigue -Empowerment integrated model allows for assessing the different paths in the relationship between work-related variables and burnout. RELEVANCE TO CLINICAL PRACTICE: These results might be essential for nursing managers to develop strategies that improve nurses' work environment and minimise their burnout during COVID-19 pandemic. These strategies should focus on enhancing co-workers' support, job satisfaction and participation in continuous education. Furthermore, paediatric nurses should be protected from any violence.

Hydrotherapy with hydrogen-rich water compared with RICE protocol following acute ankle sprain in professional athletes: a randomized non-inferiority pilot trial.

We analysed the effects of an experimental novel protocol of intensive hydrotherapy with hydrogen-rich water (HRW) on injury recovery in athletic men who suffered an acute ankle sprain (AAS) and compared it with a RICE protocol (rest, ice, compression, elevation). Professional athletes (age 23.7 ± 4.0 years; weight 78.6 ± 5.7 kg, height 182.5 ± 4.3 cm; professional experience 5.9 ± 3.9 years) who incurred AAS during a sport-related activity were randomly assigned immediately after the injury to either hydrogen group (n = 9) or a conventional RICE treatment group (n = 9). Hydrogen group received six 30-min ankle baths with HRW throughout the first 24 h post-injury, with hydrotherapy administered every 4 hours during the intervention period. RICE group stood off the injured leg, with ice packs administered for 20 min every 3 hours, with the injured ankle compressed with an elastic bandage for 24 hours and elevated at all possible times above the level of the heart. HRW was equivalent to RICE protocol to reduce ankle swelling (2.1 ± 0.9% vs. 1.6 ± 0.8%; P = 0.26), range of motion (2.4 ± 1.3 cm vs. 2.7 ± 0.8 cm; P = 0.60), and single-leg balance with eyes opened (18.4 ± 8.2 sec vs. 10.7 ± 8.0 sec; P = 0.06) and closed (5.6 ± 8.4 sec vs. 3.9 ± 4.2 sec; P = 0.59). This non-inferiority pilot trial supports the use of HRW as an effective choice in AAS management. However, more studies are needed to corroborate these findings in other soft tissue injuries.

Guanidinoacetic acid deficiency: a new entity in clinical medicine?

Guanidinoacetic acid (GAA, also known as glycocyamine or betacyamine) is a naturally-occurring derivative of glycine and a direct metabolic precursor of creatine, a key player in high-phosphate cellular bioenergetics. GAA is found in human serum and urine, with circulating GAA likely reflects an equilibrium between its endogenous production and utilization/excretion. GAA deficiency (as indicated by low serum GAA) has been reported in various conditions yet this intriguing clinical entity appears to be poorly characterized as yet, either as a primary deficit or a sequel of secondary disease. This minireview article summarizes the inherited and acquired disorders with apparent GAA deficiency and discusses a possible relevance of GAA shortfall in clinical medicine.

Measurement of public health benefits of physical activity: validity and reliability study of the international physical activity questionnaire in Hungary.

BACKGROUND: To ensure accurate measurement of the health benefits of habitual physical activity in large sample epidemiological studies, physical activity questionnaires (PAQs) are the most feasible methods. Therefore, the purpose of this study was the validation and cultural adaptation to the Hungarian population of the International Physical Activity Questionnaire (IPAQ-HL). METHODS: A cross-sectional study among Hungarian healthy adults (age 21.375 ± 1.940 years, n = 120) was performed comparing measures of last 7 days IPAQ-HL self- administered questionnaire and obtained accelerometer (Actigraph GT3X) data for concurrent validity, reassessed by a random subsample (n = 33) to measure reliability. RESULTS: Our results indicate acceptable criterion validity for total physical activity, moderate to vigorous physical activity (R = 0.387, p < 0.001; R = 0.331 p < 0.001 respectively) and moderate physical activity (R = 0.193, p = 0.034). The ICC scores revealed moderate to good correlations (ICC = 0.744-0.942, p < 0.001). Moderate Kaiser-Meyer-Olkin measure (0.531, p < 0.001) and good reproducibility for vigorous, moderate to vigorous and moderate activities was found for IPAQ-HL in the studied population. Nevertheless, like analogous self-reports in other languages, it overestimates the time spent on physical activity. CONCLUSIONS: IPAQ-HL proved to be a reasonably valid measure for population prevalence epidemiological studies and is suggested for use to develop public health policy recommendations or to optimize public health interventions. However, the results on vigorous activity should be interpreted with caution, the questionnaire showed moderate validity for this particular intensity.

Cross-cultural adaptation and validation of the Global Physical Activity Questionnaire among healthy Hungarian adults.

BACKGROUND: Physical activity (PA) is an important factor among the determinants of health due to it's protective factor and preventive role. Self-reported measures such as questionnaires are most commonly used in public health studies, but may over- or underestimate actual patterns of PA. Therefore, accelerometers are widely used to assess concurrent validity. The aim of the present study was to adapt and validate the self-administered GPAQ - Hungarian version (GPAQ-H) against accelerometer data and IPAQ-Hungarian long version (IPAQ-HL) in Hungarian healthy young adults. METHODS: A cross-sectional comparative study was conducted to examine the last 7 days PA by GPAQ-H, comparing with IPAQ-HL and Actigraph GT3X accelerometer to measure concurrent validity and reliability. A convenient sample of 300 young adults was recruited in January - July 2018 at the University of Pécs, in South-Hungary, 120 participants (age 21.53 ± 1.75 years, 46.66% male) were included in the validity and reliability study. RESULTS: Significant differences between the three instruments were found (p < 0.001) in all scores, except PAQs vigorous activities (p = 0.332) and GPAQ-H and accelerometer MVPA score (p = 0.424). A moderate KMO measure was found (0.538) with a significant Barlett's test of Sphericity (279.51; p < 0.001). The total variance was explained as 81.10%. The reliability of the GPAQ-H instrument with all domain's scores was 0.521 (CI 0.371-0.644). We found in all intensity scores and sitting time good reliability scores (R = 0.899-987, p < 0.001) between the baseline and follow-up (N = 33 random subsample). The Bland-Altman plots were showed that GPAQ-H overestimates vigorous activities by 212.75 min/week (331.82-757.42) and MVPA by 104.93 min/week (- 1016.98-807.11). A high difference, 6336.79 min/week (CI 3638.18-9035.40) was revealed regarding sitting, as GPAQ-H largely underestimated the time spent sedentary. CONCLUSIONS: The Hungarian GPAQ self-administered form showed fair to moderate validity with correlation coefficients similar to other European studies. Based on our study's results it could be claimed that the GPAQ-H measurement tool is a valid and reliable questionnaire to measure the healthy Hungarian population's physical activity patterns. However, our results also proved that GPAQ-H alone is not a valid and reliable questionnaire to measure sitting time.

Associations between fitness levels and self-perceived health-related quality of life in community - dwelling for a group of older females.

BACKGROUND: For older adults perceived quality of life has been linked to the ability to accomplish everyday tasks, a functional capacity which is thought to be based upon physical fitness. Although there is a relationship between physical activity and quality of life in older adults, the fitness of older adults and its relationship to quality of life needs more investigation. Therefore, the purpose of this study was to examine the associations between self-reported health-related quality of life and physical fitness in community-dwelling older females. METHODS: A cross-sectional study between four different age groups in retirement villages from two different places of the southern and western region of Hungary, among 173 women between the ages of 58 and 94 years old. We measured physical fitness using the Fullerton Test protocol and self-perceived health quality of life using the Short-Form Health Survey. RESULTS: Group means were different in six-minute walk distance, handgrip strength, and arm curls. The youngest group of females had higher scores of fitness in these categories as compared to the oldest grouping of women. Quality of Life were also difference across age groupings although not linear across the four age categories. Moderate level positive relationship was evident between perceived physical function and certain categories of physical fitness. CONCLUSIONS: Sociability and self-motivation has a leading role in quality of life in elder population. It is worth putting a lot more emphasis into continuous cultural, social and most importantly into physical activity programs for elderly.

Discriminating low-, medium- and high-burnout nurses: Role of organisational and patient-related factors.

AIM: To discriminate low/medium/high burnout in nurses by work and patient-related indicators and explore what factors characterize these categories best. METHODS: Cross-sectional, online survey with a representative sample of nurses. Measures assessed burnout, intragroup conflict, job insecurity, overt aggression and impact of patient aggression on nurses. RESULTS: Top nurse managers experienced more burnout than middle managers or staff, middle managers also reported greater burnout than staff. Those who had never suffered aggression experienced greater burnout but less intragroup conflict and job insecurity. Staff differed on job insecurity from top and midlevel managers. The first discriminant function differentiated high burnout from medium and low; this function was characterized by exhaustion, aggression and intragroup conflict. The second function differentiated medium burnout from others; job insecurity, years worked, over aggression and overtime dominated this function. CONCLUSIONS: Burnout affects managers and staff differently; top managers may be more susceptible to burnout than reported before. Low, medium and high burnout groups require tailored interventions because of their different characteristics. IMPLICATIONS FOR NURSING MANAGEMENT: In the future, burnout assessment should focus on both organisational and care related factors. Determining levels of burnout will guide managers to improve the right aspects of practice and work environment.

[Sleep habits among preschool- and schoolchildren]. / Alvási szokások és alvásminoség óvodás- és iskoláskorú gyermekek körében.

BACKGROUND AND PURPOSE: Objective - Our aim is to evaluate sleep habits, sleep quality and influencing factors among preschool- and schoolchildren. METHODS: Two questionnaires were recorded. Questionnaire 1 dealt with sleeping habits, breastfeeding and health behavior of preschool children and infant, and it contained the abbreviated version of the Children's Sleep Habits Questionnaire. Questionnaire 2 dealt with health behavior and the application of sleep hygiene rules, as well as it contained the Athens Insomnia Scale. Subjects - We assessed a total of 1063 questionnaires: 516 kindergarten children participated in our online survey across the country; 547 primary and secondary school students participated in the 2nd questionnaire survey in Szolnok. RESULTS: Parents' observation shows that the average nighttime sleeping time of kindergarten children is 10 hours 20 minutes on weekdays and 10 hours 36 minutes on weekends. The most popular sleeping habits in kindergarten age: teal reading (65.1%) and co-sleeping (42.8%). Parents of infants used breastfeeding (50.4%) and rocking (43.2%) most frequently before sleep. Co-sleeping has a positive influence on the length of lactation. Among the preschool sleeping habits we have proved a number of positive effects of teal reading, while watching television have negative effects. The sleep quality of school-age children according to the Athens Insomnia Scale is 6.11 points (SD: 4.11), 19% of the children are insomniac. Their sleep time is 7 hours 31 minutes on weekdays and 9 hours 30 minutes on weekends. The usage of good health behavior and sleep hygiene rules positively influence sleep quality and sleep duration. CONCLUSION: With our results, we would like to draw the attention of children and parents to the importance of sleeping and using sleep hygiene rules.

[Telemetry data based on comparative study of physical activity in patients with resynchronization device]. / Reszinkronizációs készülékkel élo betegek fizikai aktivitásának összehasonlító vizsgálata telemetriás adatok alapján.

INTRODUCTION: The effect of regular physical activity on health is widely recognized, but several studies have shown its key importance for heart patients. AIM: The present study aimed to define the PA % values, and to convert them into metabolic equivalent values (MET), which describes oxygen consumption during physical activity. METHOD: A total of seventeen patients with heart disease; 3 females and 14 males; age: 57.35 yrs ± 9.54; body mass 98.71 ± 9.89 kg; average BMI 36.69 ± 3.67 were recruited into the study. The measured values from Cardiac Resynchronisation Therapy devices and outer accelerometers (ActiGraph GT3X+) were studied over a 7-day time period. Using the two sets of values describing physical performance, linear regression was calculated providing a mathematical equation, thus, the Physical Activity values in percentage were converted into MET values. RESULTS: During the 6-minute walk test the patients achieved an average of 416.6 ± 48.2 m. During 6MWT the measured values averaged at 1.85 ± 0.18 MET's, and MET values averaged at 1.12 ± 0.06 per week. It clearly shows that this test is a challenge for the patients compared to their daily regular physical activity levels. CONCLUSION: With our method, based on the values received from the physical activity sensor implanted into the resynchronisation devices, changes in patients' health status could be monitored telemetrically with the assistance from the implanted electronic device. Orv Hetil. 2017; 158(17): 748-753.

[Analysis of telemetry, on-line and non-telemetry data for characterization of the physical activity of patients with heart failure]. / Telemetriás és online nontelemetriás adatok elemzése szívelégtelen betegek fizikai aktivitásának jellemzésére.

INTRODUCTION: Several studies have demonstrated that the prevalence of heart disease can be accounted for between 0.4 and 2% in developed countries. AIM: The present study aimed to use the PA% of the telemetry data to estimate the 6-minute walk test result. METHOD: A total of seventeen patients with heart disease; 3 females and 14 males; age: 57.35 yrs ± 9.54; body mass 98.71 ± 9.89 kg; average BMI 36.69 ± 3.67 were recruited into the study. Using the two sets of values describing physical performance, linear regression was calculated providing a mathematical equation, thus, the Physical Activity % value is used to estimate the distance traveled over a 6-minute walk test. RESULTS: On further data analysis, we have come to the conclusion that the distance walked during the six-minute-long test may be measured by PA% from the data of CRT device. CONCLUSIONS: With our method, based on the values received from the physical activity sensor implanted into the resynchronisation devices, changes in patients' health status could be monitored telemetrically with the assistance from the implanted electronic device. Orv Hetil. 2017; 158(35): 1390-1395.

Different work schedules of nurses in Hungary and their effects on health.

BACKGROUND AND PURPOSE: The shift work is burdensome for nurses and may lead to health problems. Aims - The purpose of the study was to examine the nursing shift system types and to analyse the effects on nutritional status, subjective state of physical and mental health in case of different shift schedules. METHODS: In the first phase of the research 326 nurses working in changing shifts filled out the Bergen Shift Work Questionnaire after adaptation into Hungarian. 518 nurses participated in our second study in hospitals of the South-Danubian Region, in clinics of University of Pécs and at trainings organized by the Faculty of Health Sciences of the University of Pécs. RESULTS: Based on the psychometric characteristics of Bergen Shift Work Questionnaire technically it is suitable for the examination of sleeping disorders associated with shift work. Sleeping quality is worse in those working in irregular work shifts compared to those working in regular and flexible work schedules (p<0.001). The irregular work schedule is worse than the regular work schedule according to 76.6% of the nurses. According to 63.8% of the respondents the following regular work schedule is the best: after one 12-hour day shift one 12-hour night shift, followed by two days of rest. The average Body Mass Index (BMI) is 26.16 kg/m2. Since the nurses work in shift work 47.7% of them reported weight gain. Among the psychosomatic symptoms the most frequent is back pain (78.4%) related elevated BMI (p=0.013). The nurses' sense of coherence on average is 61.76 points. In case of full-time employees the sense of coherence is better than those who work in shifts (t=2.933, p=0.004). The nurses working irregular shift work asses their health worst (mean rank: 166.61; p=0.019), and their sense of coherence is lower (p=0.04). CONCLUSION: The irregularity of work schedules is stressful for nurses. Due to the health of nurses it would be useful to establish the least exhausting work schedules.

[Insomnia and habits to help to fall asleep among adults]. / Insomnia és elalvást segíto szokások felmérése felnottek körében.

INTRODUCTION: The quality of sleep can be influenced by several factors, insomnia in turn has an effect on the state of health. AIM: The aim of our survey is to measure the effects of insomnia, furthermore, the sleep affecting agents and habits to help to fall asleep among adults. METHOD: We collected the online nationwide and the written datas from the South-Transdanubia region, 455 adults filled the questionnaire which contains the Athens Insomnia Scale. RESULTS: 13.4% of participants has insomnia, it is influenced by the quality of diet (p<0.001), comsumption of coffee (p = 0.045) and the physical activity (p = 0.011), what is more in correlation with the prevalency of chronic deseases (p = 0.001) and psychosomatic symptoms (p<0.001). The most frequent causes of sleep disorders are: work-related stress (35.6%), personal-life stress (35.4%) and pain (24.2%). In case of dormition problems most of the participants watch television (52.1%) and read (33%); 7.5% and 11.4% of the responders use sleeping pills and tisane. CONCLUSIONS: We attract attention to the prevalency and effects of insomnia, and the habits to help to fall asleep. Orv. Hetil., 2016, 157(49), 1955-1959.

[Work schedules in the Hungarian health care system and the sleep quality of nurses]. / Munkarendek a hazai egészségügyi rendszerben, és az ápolók alvásminosége.

INTRODUCTION: One way of ensuring the continuity of health care is the shift work, which is burdensome and it can lead to sleep disturbances. AIM: The aim of the study was to measure the typical Hungarian nursing shift systems in hospitals, to analyse the causes of irregular work schedules, and to compare the sleep quality of nurses in different work schedules. METHOD: 236 head nurses filled out the national online survey, and 217 nurses in clinics of the University of Pécs filled the Hungarian version of Bergen Shift Work Sleep Questionnaire. RESULTS: The head nurses provided data of 8697 nurses's schedules. 51.89% of nurses work in flexible shift system. 1944 employees work in regular shift system, most of them in the following order: 12-hour day shift and 12-hour night shift, followed by a one- or two-day rest. Where there is no system of shifts, the most frequent causes are the needs of nurses and the nurse shortage. Nurses who are working in irregular shift system had worse sleep quality than nurses who are working in flexible and regular shift system (p = 0.044). CONCLUSIONS: It would be helpful if the least burdensome shift system could be established.

[Sleep quality of nurses working in shifts - Hungarian adaptation of the Bergen Shift Work Sleep Questionnaire]. / Váltott muszakban dolgozó ápolók alvásminoségének vizsgálata a magyar nyelvre adaptált Bergen Shift Work Sleep Questionnaire alkalmazásával.

INTRODUCTION: Sleep disorders among shift workers are common problems due to the disturbed circadian rhythm. The Bergen Shift Work Sleep Questionnaire assesses discrete sleep problems related to work shifts (day, evening and night shifts) and rest days. AIM: The aim of the study was to develop the Hungarian version of this questionnaire and to compare the sleep quality of nurses in different work schedules. METHOD: 326 nurses working in shifts filled in the questionnaire. The authors made convergent and discriminant validation of the questionnaire with the Athens Insomnia Scale and the Perceived Stress Questionnaire. RESULTS: The questionnaire based on psychometric characteristics was suitable to assess sleep disorders associated with shift work in a Hungarian sample. The frequency of discrete symptoms significantly (p<0.001) differed with the shifts. Nurses experienced the worst sleep quality and daytime fatigue after the night shift. Nurses working in irregular shift system had worse sleep quality than nurses working in regular and flexible shift system (p<0.001). CONCLUSIONS: The sleep disorder of nurses working in shifts should be assessed with the Hungarian version of the Bergen Shift Work Sleep Questionnaire on a nationally representative sample, and the least burdensome shift system could be established.

[HEALTH INSURANCE ASPECTS OF PHYSIOTHERAPEUTIC CARE OF NEUROLOGY DISORDERS IN OUTPATIENT CARE]. / A NEUROLÓGIAI KÓRKÉPEK FIZIOTERÁPIÁS ELLÁTÁSÁNAK EGÉSZSÉGBIZTOSÍTÁSI VONATKOZÁSAI A JÁRÓBETEG-SZAKELLÁTÁSBAN.

BACKGROUND AND PURPOSE: The aim of our study is to analyse the ambulatory rehabilitation care of patients with neurological disorders in the field of physiotherapy. METHODS: Data derive from the database of the Hungarian National Health Insurance Fund Administration (year 2009). The analyses covered patients with diagnosis "G00-G99 Diseases of the nervous system" according to the International Classification of Diseases and underwent physiotherapy treatment. RESULTS: In 2009 altogether 190986 patients with neurological disorders received physiotherapy treatment in outpatient care, representing 1331675 cases and got 388.215 million Hungarian Forint health insurance reimbursement. The number of patients with nerve, nerve root and plexus disorders was 39 patients/10 000 population for males and 66 patients/10000 population for females. The number of patients with cerebral palsy and other paralytic syndromes was 49 patients/10000 population for males and 35 patients/10000 population for females. The number of patients with episodic and paroxysmal disorders was 33 patients/10000 population for males and 52 patients/10000 population for females. CONCLUSION: In the outpatient physiotherapy care the utilization indicators for female patients were higher in nerve, nerve root and plexus disorders and episodic and paroxysmal disorders, while in cerebral palsy and other paralytic syndromes the utilization by male patients was higher. There are important age and gender inequalities in the utilization of physiotherapy care of patients with neurological disorders.